本文選題：腦梗死 + 老年人　； 參考：《中國腦血管病雜志》2017年05期

【摘要】：目的 探討老年腦梗死患者認(rèn)知功能下降的特點(diǎn)及其影響因素。方法 采取橫斷面研究,在2014年11月13日至2014年12月21日對江蘇省如皋市江安鎮(zhèn)人群進(jìn)行調(diào)查。樣本來自“如皋衰老縱向研究”,納入31個(gè)村的1 788名對象,年齡70~84歲,均為漢族,其中男830名,女958名。確認(rèn)腦梗死病史根據(jù)二級以上醫(yī)院神經(jīng)科診斷或頭部CT證實(shí)。認(rèn)知功能的評價(jià)采用改良長谷川癡呆量表,對該人群的定向力、記憶力、近記憶力、計(jì)算力及常識5個(gè)維度進(jìn)行評價(jià),總分21.5為無認(rèn)知功能障礙,≤21.5為有認(rèn)知功能障礙。采用多因素Logistic回歸分析老年腦梗死患者認(rèn)知功能下降的危險(xiǎn)因素。結(jié)果 (1)1 788名受檢者中,合并腦梗死病史133例(7.4%),無腦梗死1 655名。合并腦梗死患者高血壓的比例高于無腦梗死組[63.9%(85例)比41.7%(690例)],高密度脂蛋白膽固醇水平低于無腦梗死組[(1.40±0.29)mmol/L比(1.47±0.33)mmol/L],差異均有統(tǒng)計(jì)學(xué)意義(均P0.05)。(2)合并腦梗死患者在定向力和計(jì)算力方面存在部分受損,總體認(rèn)知功能評分為(20±7)分,較無腦梗死患者的(21±6)明顯下降,兩組比較差異有統(tǒng)計(jì)學(xué)意義(P0.05)。(3)133例腦梗死患者中,存在認(rèn)知功能障礙的76例,發(fā)生率為57.1%,其中女性59例。認(rèn)知功能障礙患者血肌酐平均值為(59±15)μmol/L,較無認(rèn)知障礙者(66±14)μmol/L明顯降低,差異有統(tǒng)計(jì)學(xué)意義(P0.05)。(4)多因素Logistic回歸分析顯示,小學(xué)以下教育程度(OR=2.86,95%CI:2.19~3.72)、女性(OR=1.85,95%CI:1.50~2.28),是老年腦梗死患者認(rèn)知功能下降的獨(dú)立危險(xiǎn)因素,較高血肌酐濃度(OR=0.96,95%CI:0.95~0.97)是保護(hù)因素。結(jié)論 腦梗死后的老年人總體認(rèn)知功能下降,尤其是定向力和計(jì)算力方面受損明顯。小學(xué)以下文化程度和女性是發(fā)生認(rèn)知障礙的獨(dú)立危險(xiǎn)因素,較高水平血肌酐可能具有一定的保護(hù)作用。
[Abstract]:Objective to investigate the characteristics and influencing factors of cognitive decline in elderly patients with cerebral infarction. Methods a cross-sectional study was carried out in Jiang'an Town, Rugao, Jiangsu Province, from November 13, 2014 to December 21, 2014. The sample came from "Rugao senescence longitudinal study", which included 1788 subjects in 31 villages, aged 70~84 years old. Among them, there were 830 men and 958 women. The history of cerebral infarction was confirmed according to the diagnosis of neurology or CT in the hospital over level two. The evaluation of cognitive function was evaluated by the modified Kyohko Hasegawa dementia scale, and the orientation, memory, memory, computational power and common sense of the population were evaluated in 5 dimensions. The total score was 21.5 with no cognitive impairment and less than 21.5. The risk factors of cognitive impairment were analyzed by multiple factor Logistic regression. Results (1) among the 1788 subjects, 133 cases (7.4%) had a history of cerebral infarction (7.4%), and 1655 had no cerebral infarction. The proportion of hypertension in the patients with cerebral infarction was higher than that in the non cerebral infarction group (85 cases) and 41.7% (690 cases)), and the high density was higher than that of the patients with cerebral infarction (690 cases). The level of lipoprotein cholesterol was lower than that of the non cerebral infarction group [(1.40 + 0.29) mmol/L ratio (1.47 + 0.33) mmol/L]), and the difference was statistically significant (P0.05). (2) the patients with cerebral infarction were partially damaged in directional and computational power, and the overall cognitive function score was (20 + 7), compared with those without cerebral infarction (21 + 6), and two groups were different. Statistical significance (P0.05). (3) of the 133 patients with cerebral infarction, there were 76 cases of cognitive dysfunction, the incidence of which was 57.1%, of which 59 cases were in women. The mean value of creatinine in cognitive dysfunction patients was (59 + 15) mu mol/L, compared with those without cognitive impairment (66 + 14) mu mol/L, the difference was statistically significant (P0.05). (4) multiple factor Logistic regression analysis The education level below primary school (OR=2.86,95%CI:2.19~3.72) and female (OR=1.85,95%CI:1.50~2.28) were independent risk factors for cognitive decline in elderly patients with cerebral infarction, and higher serum creatinine concentration (OR=0.96,95%CI:0.95~0.97) was a protective factor. Conclusion the overall cognitive function of the elderly after cerebral infarction was decreased, especially the orientation and calculation. The level of culture and women are independent risk factors for cognitive impairment, and high level of blood creatinine may have a certain protective effect.
【作者單位】： 首都醫(yī)科大學(xué)附屬北京朝陽醫(yī)院神經(jīng)內(nèi)科;同濟(jì)大學(xué)醫(yī)學(xué)院病理學(xué)與病理生理學(xué)系;復(fù)旦大學(xué)生命科學(xué)學(xué)院;如皋市人民醫(yī)院神經(jīng)內(nèi)科;
【分類號】：R743.3

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